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2.
Fungal Genet Biol ; 140: 103395, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32325168

RESUMO

Paracoccidioidomycosis (PCM) is a life-threatening systemic mycosis widely reported in the Gran Chaco ecosystem. The disease is caused by different species from the genus Paracoccidioides, which are all endemic to South and Central America. Here, we sequenced and analyzed 31 isolates of Paracoccidioides across South America, with particular focus on isolates from Argentina and Paraguay. The de novo sequenced isolates were compared with publicly available genomes. Phylogenetics and population genomics revealed that PCM in Argentina and Paraguay is caused by three distinct Paracoccidioides genotypes, P. brasiliensis (S1a and S1b) and P. restrepiensis (PS3). P. brasiliensis S1a isolates from Argentina are frequently associated with chronic forms of the disease. Our results suggest the existence of extensive molecular polymorphism among Paracoccidioides species, and provide a framework to begin to dissect the connection between genotypic differences in the pathogen and the clinical outcomes of the disease.

3.
J Clin Immunol ; 40(2): 359-366, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31940125

RESUMO

PURPOSE: Caspase-associated recruitment domain-9 (CARD9) deficiency is an inborn error of immunity that typically predisposes otherwise healthy patients to single fungal infections and the occurrence of multiple invasive fungal infections is rare. It has been described as the first known condition that predisposes to extrapulmonary Aspergillus infection with preserved lungs. We present a patient that expands the clinical variability of CARD9 deficiency. MATERIALS AND METHODS: Genetic analysis was performed by Sanger sequencing. Neutrophils and mononuclear phagocyte response to fungal stimulation were evaluated through luminol-enhanced chemiluminescence and whole blood production of the proinflammatory mediator interleukin (IL)-6, respectively. RESULTS: We report a 56-year-old Argentinean woman, whose invasive Exophiala spinifera infection at the age of 32 years was unexplained and reported in year 2004. At the age of 49 years, she presented with chronic pulmonary disease due to Aspergillus nomius. After partial improvement following treatment with caspofungin and posaconazole, right pulmonary bilobectomy was performed. Despite administration of multiple courses of antifungals, sustained clinical remission could not be achieved. We recently found that the patient's blood showed an impaired production of IL-6 when stimulated with zymosan. We also found that she is homozygous for a previously reported CARD9 loss-of-function mutation (Q289*). CONCLUSIONS: This is the first report of a patient with inherited CARD9 deficiency and chronic invasive pulmonary aspergillosis (IPA) due to A. nomius. Inherited CARD9 deficiency should be considered in otherwise healthy children and adults with one or more invasive fungal diseases.

4.
Rev. iberoam. micol ; 36(2): 93-95, abr.-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185484

RESUMO

Paciente de 21 años, de sexo masculino, infectado por el VIH y que no sigue adecuadamente el tratamiento antirretroviral, que acude a consulta debido a una erupción papular en el tronco y las extremidades, acompañada de manera simultánea por manchas hipocrómicas en la espalda. El paciente estaba afebril y hemodinámicamente estable. En el estudio micológico de las muestras clínicas de diferentes lesiones se observaron levaduras compatibles con Malassezia. Se prescribió itraconazol por vía oral, con una excelente respuesta clínica. El hallazgo del mismo agente etiológico con 2 presentaciones clínicas diferentes en un solo paciente es poco habitual


A 21 year-old man, HIV infected, and with poor adherence to antiretroviral treatment, consulted us due to a papular rash on trunk and extremities, showing simultaneously hypochromic stains on his back. He was afebrile and hemodynamically stable. In the mycological study of the clinical samples taken from different lesions, yeasts compatible with Malassezia were observed. Oral itraconazole was prescribed, with an excellent clinical response. Finding the same etiolologic agent in 2 different clinical pictures on a single patient is extremely rare


Assuntos
Humanos , Masculino , Adulto Jovem , Dermatomicoses/microbiologia , Infecções por HIV/microbiologia , Malassezia/isolamento & purificação , Administração Oral , Antifúngicos/administração & dosagem , Dermatomicoses/tratamento farmacológico , Itraconazol/administração & dosagem , Transtornos da Pigmentação/microbiologia
5.
J Fungi (Basel) ; 5(2)2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31117260

RESUMO

Aspergillosis is a set of very frequent and widely distributed opportunistic diseases. Azoles are the first choice for most clinical forms. However, the distribution of azole-resistant strains is not well known around the world, especially in developing countries. The aim of our study was to determine the proportion of non-wild type strains among the clinical isolates of Aspergillus spp. To this end, the minimum inhibitory concentration of three azoles and amphotericin B (used occasionally in severe forms) was studied by broth microdilution. Unexpectedly, it was found that 8.1% of the isolates studied have a diminished susceptibility to itraconazole. This value turned out to be similar to the highest azole resistance rate reported in different countries across the world.

6.
Rev Iberoam Micol ; 36(2): 93-95, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-30862391

RESUMO

A 21 year-old man, HIV infected, and with poor adherence to antiretroviral treatment, consulted us due to a papular rash on trunk and extremities, showing simultaneously hypochromic stains on his back. He was afebrile and hemodynamically stable. In the mycological study of the clinical samples taken from different lesions, yeasts compatible with Malassezia were observed. Oral itraconazole was prescribed, with an excellent clinical response. Finding the same etiolologic agent in 2different clinical pictures on a single patient is extremely rare.


Assuntos
Dermatomicoses/microbiologia , Infecções por HIV/microbiologia , Malassezia/isolamento & purificação , Administração Oral , Antifúngicos/administração & dosagem , Dermatomicoses/tratamento farmacológico , Humanos , Itraconazol/administração & dosagem , Masculino , Transtornos da Pigmentação/microbiologia , Adulto Jovem
7.
Rev. iberoam. micol ; 35(1): 1-10, ene.-mar. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-170915

RESUMO

Background. Cryptococcosis is still a life-threatening mycosis that continues to be of serious concern in Latin American countries, especially among HIV+positive population. However, there is not any reliable information about the prevalence of this disease in this region. Aims. The aim of this study is to report data of 2041 patients with cryptococcosis that were attended at the Infectious Diseases Hospital F. J. Muñiz over a 30 year-period. Methods. Information about demographic and clinical data, survival time and the applied treatment, was taken from the Mycology Unit database. Mycological exams from different clinical samples were performed. Cryptococcal capsular antigen in serum and cerebrospinal fluid was detected through the latex agglutination technique. Cryptococcus isolates were phenotypically identified and the genotype was determined in some of them. Susceptibility tests were carried out following M27-A3 document. Results. Seventy five percent of HIV+positive patients and 50% of the HIV-negative population were males. Mean ages were 34.1 in HIV+positive patients and 44.8 in the HIV-negative. Cryptococcosis was associated with AIDS in 98% of the cases. Meningeal compromise was seen in 90% of the patients. Although cerebrospinal fluid rendered more positive results, blood culture was the first diagnostic finding in some cases. Cryptococcal antigen showed positive results in 96.2% of the sera samples and in the 93.1% of the cerebrospinal fluid samples. Most of the isolates were Cryptococcus neoformans and belonged to genotype VNI. Minimal inhibitory concentration values were mostly below the epidemiological cutoff values. Conclusions. We observed that thanks to a high level of clinical suspicion, early diagnosis, combined therapy and intracranial pressure control by daily lumbar punctures, the global mortality rate has markedly decreased through the years in the analyzed period (AU)


Antecedentes. La criptococosis es una micosis grave y un motivo de preocupación en América Latina, en especial en los pacientes positivos para el VIH. Sin embargo, no existen aún datos regionales fiables acerca de la prevalencia de la enfermedad. Objetivos. Presentar los datos de 2.041 pacientes con criptococosis atendidos en la Unidad de Micología del Hospital de Infecciosas F. J. Muñiz de Buenos Aires, recogidos en un período de 30 años. Métodos. Se presentan datos demográficos, diagnósticos, clínicos y el tiempo de supervivencia de los pacientes, obtenidos de la base de datos de la Unidad de Micología. Se realizaron exámenes micológicos de diversas muestras clínicas, además de antigenemia y antigenorraquia por aglutinación de látex para Cryptococcus en el momento del diagnóstico y durante el seguimiento. Se llevó a cabo la identificación fenotípica de los aislamientos y en numerosos casos también se efectuó la genotipificación. La determinación de los valores de concentración mínima inhibitoria frente a diversos antifúngicos se realizó según el documento M27-A3 (CLSI). Resultados. El 75% de los pacientes positivos para el VIH y el 50% de los no portadores eran varones; la media de edad fue 34,1 años para los positivos para el VIH y 44,8 para los no portadores. La criptococosis se asoció con el sida en el 98% de los casos y el 90% de ellos presentó compromiso meníngeo. Aunque la muestra clínica con mayor porcentaje de resultados positivos fue el LCR, en numerosas ocasiones el hemocultivo fue el primer elemento diagnóstico. La antigenemia fue positiva en el 96,2% de los casos y la antigenorraquia en el 93,1%. La mayor parte de las cepas era Cryptococcus neoformans y pertenecía al genotipo VNI, y la concentración mínima inhibitoria en las pruebas de sensibilidad a los antifúngicos de la mayoría de ellos mostró valores inferiores al punto de corte epidemiológico. Conclusiones. Observamos que un alto nivel de sospecha clínica, el diagnóstico temprano, el tratamiento combinado y el control de la presión intracraneal mediante punciones lumbares diarias han permitido disminuir la mortalidad global a lo largo de los años en el período analizado (AU)


Assuntos
Humanos , Cryptococcus/isolamento & purificação , Criptococose/epidemiologia , Antifúngicos/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções por HIV/complicações , Diagnóstico Precoce , Hipertensão Intracraniana/diagnóstico , Punção Espinal , Técnicas de Tipagem Micológica , Argentina/epidemiologia
8.
Rev. iberoam. micol ; 35(1): 56-58, ene.-mar. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-170923

RESUMO

No disponible


A 48 year-old immunocompetent woman, who had a nodular lesion in the neck and a dense infiltrate at the lower lobe of the left lung, presented at the Mycology Unit of Muñiz Hospital of Buenos Aires City. The pulmonary infiltrate disappeared spontaneously 3 months later. The histopathological study of the nodular lesion showed capsulated yeasts (mucicarmin and alcian blue positive stains) compatible with Cryptococcus. The mycological study of a new sample, obtained by a nodular puncture, allowed the isolation of yeasts, identified as Cryptococcus gattii (VGII). Latex test for Cryptococcus capsular antigen in serum was positive (1/100). CSF cultures rendered negative results. Fluconazole at a daily dose of 800mg was given during 45 days with partial improvement; as cultures from a new clinical sample were positive for Cryptococcus, the antimycotic was changed to itraconazole 400mg/day for 5 months, with an excellent clinical response (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cryptococcus gattii/isolamento & purificação , Criptococose/microbiologia , Pneumopatias Fúngicas/microbiologia , Fluconazol/uso terapêutico , Cromatografia de Afinidade , Testes de Fixação do Látex
9.
Rev. iberoam. micol ; 35(1): 59-61, ene.-mar. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-170924

RESUMO

No disponible


The case of a 60 year old woman with hemoptysis and a thin-walled cavitary lesion at the upper lobe of the right lung is presented. The woman presented at the Mycology Unit of the Muñiz Hospital in Buenos Aires City 3 months after the beginning of her clinical manifestations. A hyaline micelial fungus with chlamido-arthroconidias was isolated from the bronchoalveolar lavage. Immunodiffusion and counter-immnunoelectrophoresis with coccidioidin and histoplasmin rendered positive results against both antigents, and skin tests with coccidioidin and histoplasmin were also positive with strong reactions. The isolated fungus was identified as Coccidioides posadasii at the National Microbiology Institute Carlos Malbrán, by means of a molecular technique. The patient was treated with itraconazole by oral route at a daily dose of 200mg with good clinical response, but due to the persistence of the lung cavity, a surgical removal of the upper lobe of the right lung had to be scheduled (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Hemoptise/etiologia , Pneumopatias Fúngicas/diagnóstico , Coccidioidomicose/diagnóstico , Líquido da Lavagem Broncoalveolar/microbiologia , Diagnóstico Diferencial , Itraconazol/uso terapêutico
10.
Rev Chilena Infectol ; 35(5): 560-565, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30725004

RESUMO

BACKGROUND: Histoplasmosis is a mycosis with a high prevalence in HIV/AIDS patients. Clinical presentation includes a wide spectrum of manifestations and diagnosis usually takes up to several weeks in patients who do not present cutaneous lesions. AIM: To determine the clinical and microbiological characteristics as well as some biochemical parameters in patients with AIDS-associated histoplasmosis without tegumentary lesions, in order to develop a guideline which enables an early empiric treatment in cases of difficult diagnosis. METHODS: Medical records of 86 patients with histoplasmosis were reviewed; 31 patients with diagnosis of AIDS-associated histoplasmosis without cutaneous lesions were analyzed. RESULTS: Fever was the most frequent symptom (96.7%), lung involvement was observed in 22 patients (70.9%), the most commonly radiological pattern was miliary pattern [(12/22), 54.5%]. Nineteen patients presented with splenomegaly. Blood culture sensitivity was 93.3% (28/30) and serology was positive only in 23.5% of the cases. Eight patients died (25.8%). Patients in which CD4+ T cell lymphocytes count was < 50 cells/µl, albumin levels < 2.5 g/dl and who presented with pancytopenia had an unfavorable outcome. CONCLUSIONS: In HIV seropositive patients with fever associated to splenomegaly and bilateral miliar pattern in chest radiography, the empiric treatment with amphotericin B must be considered if signs and symptoms of unfavorable outcome are present and due to the time that it takes to arrive at an accurate diagnosis. In order to confirm the diagnosis, all microbiological samples should be collected prior to initiating therapy.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Dermatomicoses/diagnóstico , Histoplasmose/diagnóstico , Doença Aguda , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
11.
Rev Iberoam Micol ; 35(1): 59-61, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29191631

RESUMO

The case of a 60 year old woman with hemoptysis and a thin-walled cavitary lesion at the upper lobe of the right lung is presented. The woman presented at the Mycology Unit of the Muñiz Hospital in Buenos Aires City 3 months after the beginning of her clinical manifestations. A hyaline micelial fungus with chlamido-arthroconidias was isolated from the bronchoalveolar lavage. Immunodiffusion and counter-immnunoelectrophoresis with coccidioidin and histoplasmin rendered positive results against both antigents, and skin tests with coccidioidin and histoplasmin were also positive with strong reactions. The isolated fungus was identified as Coccidioides posadasii at the National Microbiology Institute Carlos Malbrán, by means of a molecular technique. The patient was treated with itraconazole by oral route at a daily dose of 200mg with good clinical response, but due to the persistence of the lung cavity, a surgical removal of the upper lobe of the right lung had to be scheduled.


Assuntos
Coccidioides/isolamento & purificação , Coccidioidomicose/microbiologia , Pneumopatias Fúngicas/microbiologia , Antifúngicos/uso terapêutico , Antígenos de Fungos/sangue , Coccidioides/imunologia , Coccidioidomicose/diagnóstico por imagem , Coccidioidomicose/tratamento farmacológico , Coccidioidomicose/cirurgia , Feminino , Hemoptise/etiologia , Humanos , Itraconazol/uso terapêutico , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
12.
Rev Iberoam Micol ; 35(1): 56-58, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29169813

RESUMO

A 48 year-old immunocompetent woman, who had a nodular lesion in the neck and a dense infiltrate at the lower lobe of the left lung, presented at the Mycology Unit of Muñiz Hospital of Buenos Aires City. The pulmonary infiltrate disappeared spontaneously 3 months later. The histopathological study of the nodular lesion showed capsulated yeasts (mucicarmin and alcian blue positive stains) compatible with Cryptococcus. The mycological study of a new sample, obtained by a nodular puncture, allowed the isolation of yeasts, identified as Cryptococcus gattii (VGII). Latex test for Cryptococcus capsular antigen in serum was positive (1/100). CSF cultures rendered negative results. Fluconazole at a daily dose of 800mg was given during 45 days with partial improvement; as cultures from a new clinical sample were positive for Cryptococcus, the antimycotic was changed to itraconazole 400mg/day for 5 months, with an excellent clinical response.


Assuntos
Criptococose/diagnóstico , Cryptococcus gattii/isolamento & purificação , Cistos/microbiologia , Fungemia/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Doenças da Glândula Tireoide/microbiologia , Antifúngicos/uso terapêutico , Antígenos de Fungos/sangue , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Criptococose/patologia , Cryptococcus gattii/imunologia , Feminino , Fluconazol/uso terapêutico , Fungemia/tratamento farmacológico , Fungemia/microbiologia , Fungemia/patologia , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/patologia , Pessoa de Meia-Idade
13.
Rev Iberoam Micol ; 35(1): 1-10, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29129578

RESUMO

BACKGROUND: Cryptococcosis is still a life-threatening mycosis that continues to be of serious concern in Latin American countries, especially among HIV+positive population. However, there is not any reliable information about the prevalence of this disease in this region. AIMS: The aim of this study is to report data of 2041 patients with cryptococcosis that were attended at the Infectious Diseases Hospital F. J. Muñiz over a 30 year-period. METHODS: Information about demographic and clinical data, survival time and the applied treatment, was taken from the Mycology Unit database. Mycological exams from different clinical samples were performed. Cryptococcal capsular antigen in serum and cerebrospinal fluid was detected through the latex agglutination technique. Cryptococcus isolates were phenotypically identified and the genotype was determined in some of them. Susceptibility tests were carried out following M27-A3 document. RESULTS: Seventy five percent of HIV+positive patients and 50% of the HIV-negative population were males. Mean ages were 34.1 in HIV+positive patients and 44.8 in the HIV-negative. Cryptococcosis was associated with AIDS in 98% of the cases. Meningeal compromise was seen in 90% of the patients. Although cerebrospinal fluid rendered more positive results, blood culture was the first diagnostic finding in some cases. Cryptococcal antigen showed positive results in 96.2% of the sera samples and in the 93.1% of the cerebrospinal fluid samples. Most of the isolates were Cryptococcus neoformans and belonged to genotype VNI. Minimal inhibitory concentration values were mostly below the epidemiological cutoff values. CONCLUSIONS: We observed that thanks to a high level of clinical suspicion, early diagnosis, combined therapy and intracranial pressure control by daily lumbar punctures, the global mortality rate has markedly decreased through the years in the analyzed period.


Assuntos
Criptococose/epidemiologia , Adulto , Antifúngicos/uso terapêutico , Argentina/epidemiologia , Comorbidade , Criptococose/complicações , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Cryptococcus gattii/efeitos dos fármacos , Cryptococcus gattii/isolamento & purificação , Cryptococcus neoformans/efeitos dos fármacos , Cryptococcus neoformans/isolamento & purificação , Farmacorresistência Fúngica , Diagnóstico Precoce , Feminino , Infecções por HIV/epidemiologia , Hospitais Especializados/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Infectologia , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/terapia , Masculino , Pessoa de Meia-Idade , Micologia/métodos , Punção Espinal
14.
Rev. chil. infectol ; 35(5): 560-565, 2018. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-978070

RESUMO

Resumen Antecedentes: La histoplasmosis es una micosis de gran relevancia en pacientes con SIDA. El cuadro clínico puede ser muy variado y, en enfermos que no desarrollan lesiones cutáneas, el diagnóstico suele demorar varias semanas. Objetivo: Establecer pautas que permitan emplear un tratamiento empírico y precoz en pacientes con histoplasmosis asociada al SIDA sin manifestaciones tegumentarias y determinar las características clínicas, microbiológicas y algunos parámetros bioquímicos en los casos de difícil diagnóstico. Métodos: Se analizaron las historias clínicas de 86 pacientes con histoplasmosis. Fueron seleccionados 31 enfermos con histoplasmosis asociada con SIDA sin lesiones cutáneas. Resultados: La fiebre fue el síntoma más frecuente (96,7%), el compromiso pulmonar se comprobó en 22 enfermos (70,9%). El patrón radiológico más frecuentemente hallado en las radiografías de tórax fue el miliar o micronodulillar bilateral [(12/22), 54,5%]. Diecinueve enfermos presentaron esplenomegalia. Los hemocultivos demostraron una sensibilidad de 93,3% (28/30) y la serología fue positiva en 23,5% de los casos. Fallecieron ocho pacientes (25,8%). Los pacientes con recuentos de linfocitos T CD4+ menores a 50 céls/μl, albúmina menor a 2,5 g/dl y pancitopenia evidenciaron un pronóstico desfavorable. Conclusiones: En los pacientes con infección por VIH, fiebre asociada a esplenomegalia y lesiones micronodulillares bilaterales en la radiografía de tórax debe considerarse el tratamiento empírico con anfotericina B cuando existan signos o síntomas de mal pronóstico, debido al tiempo de demora hasta el diagnóstico definitivo. Previo a iniciar el tratamiento deben tomarse todas las muestras para los estudios microbiológicos que permitan confirmar luego la presunción diagnóstica.


Background: Histoplasmosis is a mycosis with a high prevalence in HIV/AIDS patients. Clinical presentation includes a wide spectrum of manifestations and diagnosis usually takes up to several weeks in patients who do not present cutaneous lesions. Aim: To determine the clinical and microbiological characteristics as well as some biochemical parameters in patients with AIDS-associated histoplasmosis without tegumentary lesions, in order to develop a guideline which enables an early empiric treatment in cases of difficult diagnosis. Methods: Medical records of 86 patients with histoplasmosis were reviewed; 31 patients with diagnosis of AIDS-associated histoplasmosis without cutaneous lesions were analyzed. Results: Fever was the most frequent symptom (96.7%), lung involvement was observed in 22 patients (70.9%), the most commonly radiological pattern was miliary pattern [(12/22), 54.5%]. Nineteen patients presented with splenomegaly. Blood culture sensitivity was 93.3% (28/30) and serology was positive only in 23.5% of the cases. Eight patients died (25.8%). Patients in which CD4+ T cell lymphocytes count was < 50 cells/μl, albumin levels < 2.5 g/dl and who presented with pancytopenia had an unfavorable outcome. Conclusions: In HIV seropositive patients with fever associated to splenomegaly and bilateral miliar pattern in chest radiography, the empiric treatment with amphotericin B must be considered if signs and symptoms of unfavorable outcome are present and due to the time that it takes to arrive at an accurate diagnosis. In order to confirm the diagnosis, all microbiological samples should be collected prior to initiating therapy.

15.
Rev. chil. infectol ; 34(5): 502-506, oct. 2017. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-899750

RESUMO

Resumen La aspergilosis cerebral es una patología infrecuente, pero de elevada mortalidad en pacientes con SIDA. Es importante considerarla entre los diagnósticos diferenciales ante una lesión expansiva cerebral. Se requiere un alto grado de sospecha para poder realizar un diagnóstico precoz. Se presenta el caso de un paciente con infección por VIH con un cuadro neurológico rápidamente progresivo por Aspergillus sección flavi. Se realiza una revisión de 40 casos publicados de aspergilosis cerebral en pacientes con SIDA.


Cerebral aspergillosis is a rare disease with high mortality rates in AIDS patients. It is important to take this into account in the differential diagnosis of a brain expansive lesion. A high level of suspicion is required to make an early diagnosis. We present a case of an HIV-infected patient with progresive neurological disease caused by Aspergillus flavi. We review 40 previously published cases of central nervous system aspergillosis in patients with AIDS.

16.
Rev. patol. trop ; 46(2): 135-145, jun. 2017. tab
Artigo em Inglês | LILACS | ID: biblio-913455

RESUMO

Histoplasmosis is a systemic mycosis frequently affecting patients infected with HIV, appearing as acute or subacute disseminated forms. Early diagnosis is simple when muco-cutaneous lesions are present; but in their absence the use of non-culture based methods is usually required presenting a fundamental challenge for the management and prognosis of this infection. The aim of this study was to analyze the sensitivity and specificity of an Elisa kit for the detection of the galactomannan antigen of Histoplasma capsulatum in different clinical samples. A total of 98 clinical samples obtained from different organic fluids were analyzed: 66 sera, 28 urine samples, 3 bronchoalveolar lavages and one cerebrospinal fluid. They corresponded to a total of 61 patients: 27 with histoplasmosis associated with AIDS, 7 histoplasmosis in nonreactive HIV individuals and 27 patients with other diseases but which were clinically similar to histoplasmosis. The sensitivity of the detection of the galactomannan antigen in serum of patients with histoplasmosis and AIDS was 76% and the specificity was 56%. In urine samples of this group of patients the sensitivity was 75%


Assuntos
Histoplasmose , Histoplasma , Micoses , Antígenos
17.
Rev. iberoam. micol ; 34(2): 94-98, abr.-jun. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-162496

RESUMO

Antecedentes. La histoplasmosis clásica es una micosis sistémica endémica debida a Histoplasma capsulatum var. capsulatum. En los pacientes VIH/sida afectados por esta infección, la restauración de la respuesta inmune mediante el tratamiento antirretroviral de alta eficacia (TARV) y la profilaxis secundaria con antifúngicos ha reducido su morbimortalidad. Objetivos. Conocer el estado actual del pronóstico y los resultados de los tratamientos de esta asociación mórbida en el Hospital de Infecciosas Francisco J. Muñiz, de Buenos Aires. Métodos. Estudio retrospectivo de los datos demográficos, clínicos, inmunológicos y de tratamiento de 80 pacientes infectados por el VIH con histoplasmosis diseminada. Resultados. Sesenta y cinco pacientes eran varones, la mediana de la edad fue de 36 años, el 73,7% consumía drogas ilegales, el 82,5% no recibía TARV en el momento del diagnóstico y el 58,7% presentaba recuentos de CD4+ inferiores a 50cél/μl. El tratamiento inicial (anfotericina B y/o itraconazol) duró 3 meses y fue exitoso en el 78,7% de los enfermos. Solo 26/63 (41,2%) cumplieron con los controles clínicos posteriores, el TARV y la profilaxis secundaria con itraconazol o anfotericina B. Se suspendió la profilaxis secundaria tras más de un año de TARV si los pacientes estaban asintomáticos, y si presentaban dos recuentos de CD4+ superiores a 150cél/μl y cargas virales indetectables. Después de dos años de control postinterrupción de la profilaxis, ningún caso experimentó recidiva. Conclusiones. El tratamiento de la histoplasmosis en pacientes infectados por el VIH fue eficaz en el 78,8% de los casos; la asociación de TARV y profilaxis antifúngica es segura, bien tolerada y eficaz. En el futuro debe mejorarse el cumplimiento de la terapia en estos pacientes e incorporar métodos de diagnóstico rápido de la histoplasmosis. Debe estudiarse la utilidad de la profilaxis primaria para la criptococosis y la histoplasmosis en los pacientes infectados por el VIH (AU)


Background. Classic histoplasmosis is a systemic endemic mycosis due to Histoplasma capsulatum var. capsulatum. A significant reduction in the morbidity and mortality of AIDS-related histoplasmosis has been observed since the introduction of highly active antiretroviral therapy (HAART) and secondary antifungal prophylaxis. Aims. The aim of this study was to determine the current state of prognosis and treatment response of HIV-positive patients with histoplasmosis in the Francisco J. Muñiz Infectious Diseases Hospital in Buenos Aires City. Methods. A retrospective study was conducted using the demographic, clinical, immunological and treatment data of 80 patients suffering from AIDS-related histoplasmosis. Results. Of the 80 cases studied 65 were male, the median age was 36 years, with 73.7% of the patients being drug addicts, 82.5% of the patients was not receiving HAART at diagnosis, and 58.7% of the cases had less than 50 CD4+ cells/μl at the beginning of the treatment. The initial phase of treatment consisted of intravenous amphotericin B and/or oral itraconazole for 3 months, with 78.7% of the cases showing a good clinical response. Only 26/63 patients who were discharged from hospital continued with the follow-up of the HAART, secondary prophylaxis with itraconazole or amphotericin B. Secondary prophylaxis was stopped after more than one year of HAART if the patients were asymptomatic, had two CD4+ cell counts greater than 150cells/μl, and undetectable viral loads. No relapses were observed during a two-year follow up after prophylaxis was stopped. Conclusions. The treatment of histoplasmosis in HIV-positive patients was effective in 78.8% of the cases. The combination of HAART and secondary antifungal prophylaxis is safe, well tolerated, and effective. The low adherence of patients to HAART and the lack of laboratory kits for rapid histoplasmosis diagnosis should be addressed in the future. The usefulness of primary antifungal prophylaxis for cryptococcosis and histoplasmosis HIV-positive patients should be studied (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Antifúngicos/farmacocinética , Histoplasmose/tratamento farmacológico , Infecções por HIV/complicações , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Estudos Retrospectivos , Itraconazol/farmacocinética , Anfotericina B/farmacocinética
18.
Rev Iberoam Micol ; 34(2): 94-98, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-28391953

RESUMO

BACKGROUND: Classic histoplasmosis is a systemic endemic mycosis due to Histoplasma capsulatum var. capsulatum. A significant reduction in the morbidity and mortality of AIDS-related histoplasmosis has been observed since the introduction of highly active antiretroviral therapy (HAART) and secondary antifungal prophylaxis. AIMS: The aim of this study was to determine the current state of prognosis and treatment response of HIV-positive patients with histoplasmosis in the Francisco J. Muñiz Infectious Diseases Hospital in Buenos Aires City. METHODS: A retrospective study was conducted using the demographic, clinical, immunological and treatment data of 80 patients suffering from AIDS-related histoplasmosis. RESULTS: Of the 80 cases studied 65 were male, the median age was 36 years, with 73.7% of the patients being drug addicts, 82.5% of the patients was not receiving HAART at diagnosis, and 58.7% of the cases had less than 50 CD4+ cells/µl at the beginning of the treatment. The initial phase of treatment consisted of intravenous amphotericin B and/or oral itraconazole for 3 months, with 78.7% of the cases showing a good clinical response. Only 26/63 patients who were discharged from hospital continued with the follow-up of the HAART, secondary prophylaxis with itraconazole or amphotericin B. Secondary prophylaxis was stopped after more than one year of HAART if the patients were asymptomatic, had two CD4+ cell counts greater than 150cells/µl, and undetectable viral loads. No relapses were observed during a two-year follow up after prophylaxis was stopped. CONCLUSIONS: The treatment of histoplasmosis in HIV-positive patients was effective in 78.8% of the cases. The combination of HAART and secondary antifungal prophylaxis is safe, well tolerated, and effective. The low adherence of patients to HAART and the lack of laboratory kits for rapid histoplasmosis diagnosis should be addressed in the future. The usefulness of primary antifungal prophylaxis for cryptococcosis and histoplasmosis HIV-positive patients should be studied.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antifúngicos/uso terapêutico , Histoplasmose/tratamento farmacológico , Itraconazol/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Adulto , Fármacos Anti-HIV/farmacocinética , Fármacos Anti-HIV/uso terapêutico , Antifúngicos/efeitos adversos , Antifúngicos/farmacocinética , Terapia Antirretroviral de Alta Atividade , Argentina/epidemiologia , Contagem de Linfócito CD4 , Interações Medicamentosas , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Histoplasma/efeitos dos fármacos , Histoplasmose/epidemiologia , Histoplasmose/imunologia , Histoplasmose/prevenção & controle , Hospitais Especializados , Humanos , Infectologia , Itraconazol/efeitos adversos , Itraconazol/farmacocinética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/complicações , Carga Viral , Adulto Jovem
19.
Rev. iberoam. micol ; 34(1): 53-55, ene.-mar. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-160737

RESUMO

No disponible


We present the case of a 34 year-old man, HIV-positive, who had suffered a disseminated histoplasmosis treated with amphotericin B one year before his admission. He was admitted at the Infectious Diseases Muñiz Hospital with a non-lithiasic chlolecystitis. During the clinical examination perigenital skin lesions compatible with tinea cruris, as well as proximal subungual onychomycoses of toenails, were observed. Microsporum gypseum was isolated from both types of lesions. Oral terbinafine led to a good clinical response. Treatment prescription was a big challenge in this patient because he was receiving HAART and itraconazole, and there was scarce experience in the treatment of nail infections due to M. gypseum (AU)


Assuntos
Humanos , Masculino , Adulto , Onicomicose/diagnóstico , Onicomicose/tratamento farmacológico , Onicomicose/microbiologia , Itraconazol/uso terapêutico , Anfotericina B/uso terapêutico , Radiografia Torácica/instrumentação , Radiografia Torácica/métodos , Tinha/complicações , Tinha/tratamento farmacológico , Infecções por HIV/complicações , Colecistite/complicações , Colecistite/diagnóstico , Colecistostomia/métodos , Combinação Elvitegravir, Cobicistat, Emtricitabina e Fumarato de Tenofovir Desoproxila/uso terapêutico
20.
Rev Chilena Infectol ; 34(5): 502-506, 2017 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-29488596

RESUMO

Cerebral aspergillosis is a rare disease with high mortality rates in AIDS patients. It is important to take this into account in the differential diagnosis of a brain expansive lesion. A high level of suspicion is required to make an early diagnosis. We present a case of an HIV-infected patient with progresive neurological disease caused by Aspergillus flavi. We review 40 previously published cases of central nervous system aspergillosis in patients with AIDS.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Encefalopatias/microbiologia , Neuroaspergilose/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Encefalopatias/diagnóstico , Encefalopatias/imunologia , Diagnóstico Diferencial , Evolução Fatal , Humanos , Imunocompetência , Imagem por Ressonância Magnética , Masculino , Neuroaspergilose/diagnóstico , Neuroaspergilose/imunologia
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